Wmd Form 2004 12 PDF Details

In December 2004, the Department of Homeland Security (DHS) released a report outlining the results of their preliminary investigation into the use of weapons of mass destruction (WMD) in the United States. The report, called "WMD Form 2004 12", detailed twelve potential instances in which WMD could be used to cause large-scale loss of life or disruption. While some of the threats were more credible than others, all posed a serious risk to public safety. In light of recent events both here and abroad, it's important that we remember and learn from these potential threats.

QuestionAnswer
Form NameWmd Form 2004 12
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessample of usa military form, military registration form, soldiers forms, what to do when applying military forms

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MILITARY DEPARTMENT

DISCLOSURE/REQUEST FOR OUTSIDE EMPLOYMENT FORM

 

 

EMPLOYEE INFORMATION

Name (Last, First, MI)

 

 

Personnel Number

 

 

 

 

Division

Unit

 

Job Classification

 

 

 

 

Work Phone Number:

 

 

Work Email Address

 

 

 

 

INFORMATION REGARDING OUTSIDE EMPLOYMENT

Name of Outside Employer or Organization

Business & Occupation #:

Tax ID #

 

 

Address of Outside Employer:

Location of Outside Employment (if different from

 

mailing address):

 

 

Job Title

Business e-mail address:

 

 

Name of Immediate Supervisor

Supervisor Contact Information (phone and e-mail)

 

 

Describe the Outside Employer’s business:

Describe the specific job duties you will perform for this outside employer, or attach a current position description (preferred):

Average weekly paid or volunteer hours worked

Average weekly paid or volunteer hours worked

 

 

Please check YES or NO for the questions. If you answer YES” to any of the above questions, please explain your affirmative response(s) either on this form, or attach a separate signed statement explaining your response.

Yes

No

Is this outside employer a client or customer of WMD and/or any of its divisions?

 

 

 

Yes

No

Does this outside employer do business with, or try to influence, WMD or other

 

 

state government policies (i.e. lobbying)?

 

 

 

Yes

No

Would this outside employment involve paid activities which are normally a part of

 

 

your WMD duties?

 

 

 

Yes

No

Do you know of any other factors which could create an actual, or perceived by

 

 

others, conflict of interest with your state employment?

 

 

 

WMD FORM 2004-12

Yes

No

Does this outside employer conduct operations, or activities, which are regulated

 

 

by WMD?

 

 

 

Explanation for areas in which you marked yes on the previous page (attach additional pieces of paper if necessary).

By my signature, I certify that this information is true and complete to the best of my knowledge. I also certify that I I have read and understand Washington Military Department Policy #HR-241-02 pertaining to WMD State Employees engaging in Outside Employment. Further, I understand this outside employment report will be placed in both my personnel and payroll files.

 

 

 

 

 

 

 

 

 

 

 

 

NAME:

 

 

 

DATE:

 

 

 

 

 

 

 

 

APPROVAL PROCESS

 

 

 

 

Office / Function

 

 

Recommendation

 

Signature

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approval

 

 

 

 

 

 

 

Supervisor

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approval

 

 

 

 

 

 

 

 

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Manager

 

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPROVAL

 

 

 

 

 

 

 

 

Approval

 

 

 

 

 

 

 

EMT Director

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approval

 

 

 

 

 

 

 

HR Director

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Director (TAG) Review

 

 

Approval

 

 

 

 

 

 

 

(if required)

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

cc:Payroll file Personnel file

WMD FORM 2004-12

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